Monitoring of Peripheral Blood CD34+ Cell Counts on the First Day of Apheresis Is Highly Predictive for Efficient CD34+ Cell Yield

Abstract

The purpose of this study was to evaluate the correlation of preleukapheresis circulating CD34+ cells/μL, white blood cells (WBC), and platelet counts on the first day of apheresis with the yield of collected CD34+ cell counts in 40 patients with hematological malignancies (n = 29) and solid tumors (n = 11). The median numbers of apheresis cycles, numbers of CD34+ cells, peripheral blood (PB) mononuclear cells, and total nucleated cells collected were 2 (range, 1–4), 5.5 × 106/kg (range, 0.05–33.78), 2.59 × 108/kg (range, 0.04–20.68), and 7.36 × 108/kg (range, 0.15–28.08), respectively. There was a strong correlation between the number of preleukapheresis circulating CD34+ cells/μL and the yield of collected CD34+ cells per kilogram (r = 0.962, p < 0.001). The threshold levels of PB CD34+ cell/μL to obtain ≥1 × 106/kg and ≥2.5 × 106/kg CD34+ cell in one collection were 12/μL and 34/μL, respectively. Fifteen of 17 (88%) patients who had ≥34 CD34+ cells/μL in the PB before collection reached the level of ≥2.5 × 106/kg in a single apheresis. Despite a low r value, WBC and platelet counts on the first day of apheresis also correlated with the yield of collected daily CD34+ cells per kilogram (r = 0.482, p < 0.01 and r = 0.496 p < 0.01, respectively). These data suggest that preleukapheresis circulating CD34+ cells/μL correlated significantly better with the yield of collected CD34+ cells than WBC and platelet counts on the first day of apheresis. Using a value of 34/μL preleukapheresis circulating CD34+ cells as a guide for the timing of peripheral blood stem cells collections can be time saving and cost‐effective.

A randomized study comparing filgrastim versus lenograstim versus molgramostim plus chemotherapy for peripheral blood progenitor cell mobilization

“…These results were discordant with those described by other authors who reported a number of CD34 þ cells in the peripheral blood resulted a reliable predictor for estimating PBPC yield. 6,26 Demirer et al 27 reported that preleukapheresis circulating CD34 þ cells/ml correlated significantly better with the yield of collected CD34 þ cells than WBC and platelet counts on the first day of apheresis with a threshold level of circulating CD34 þ cells before apheresis, which was around the 30-50/ml. In our study, the lowest level was 61/ml (in the molgramostim arm).…”

A risk-based approach to optimize autologous hematopoietic stem cell (HSC) collection with the use of plerixafor

“…As approximately 15-30% of patients fail to mobilize adequately with G-CSF alone, one strategy would be to limit the use of plerixafor to patients who have failed initial mobilization. However, remobilization is costly 13 and adds a significant delay in proceeding to transplantation. Another strategy would be to identify potential poor mobilizers upfront, and target the use of plerixafor to this population.…”

“…Similar findings have been reported from other centers. 13,17 Applying this approach, we developed a practical risk-based algorithm shown in Table 1, with the following goals: (1) to identify likely poor and slow mobilizers upfront, and use plerixafor in these selected patients; (2) to minimize the number of days needed for adequate HSC collection.…”

High-dose thiotepa, melphalan and carboplatin (TMCb) followed by autologous peripheral blood stem cell transplantation in patients with lymphoma – a retrospective evaluation

“…The techniques of PBSC harvest, cryopreservation, thawing, and transfusion have been described elsewhere. [15][16][17] Based on our previous studies, a minimum cell dose of 2.5 Â 10 6 /kg was established and a target dose of 4 Â 10 6 /kg CD34 þ cells/kg was used. 18,19 Day 0 designates the day of PBSC infusion.…”